Robert Balogh

Emergency department visits and use of outpatient physician services by adults with developmental disability and psychiatric disorder.

Objective: To compare the emergency department (ED), primary, and psychiatric care visit rates associated with the presence and absence of a developmental disability (DD) and a mental illness. Method: This is a population-based study comparing Ontario adults, with and without DDs and mental illnesses, in terms of rates of primary, psychiatric, and ED care, from April 2007 to March 2009. Results: In Ontario, 45% of adults with a DD received a psychiatric diagnosis during a 2-year period, and 26% of those with a psychiatric diagnosis were classified as having a serious mental illness (SMI), compared with 8% of those with a psychiatric diagnosis but no DD. People with DDs had an increased likelihood of psychiatric and ED visits. Patients with SMIs and DDs had the highest rates of such visits. Conclusions: People with more severe impairments had the greatest likelihood of ED visits, despite access to outpatient services, suggesting that outpatient care (primary and psychiatric), as currently delivered, may not be adequate to meet their complex needs.

Dual Diagnosis: A National Study of Psychiatric Hospitalization Patterns of People with Developmental Disability

Objective: To report national demographics and diagnostic profiles of people with developmental disability hospitalized for psychiatric reasons, and to contrast results to psychiatric hospitalizations among patients with no comorbid developmental disability. Method: People with developmental disability across Canada were identified using data administered by the Canadian Institute for Health Information. Among this cohort of people with developmental disability, records of hospitalization for psychiatric reasons were aggregated for the 2005/06 fiscal year (April 2005 to March 2006). Descriptive statistics on province of residence, age, sex, specific diagnoses, length of stay, and hospitalization frequency were calculated and compared with people without developmental disability. Results: In Canada, people with developmental disability were hospitalized a total of 8378 times in 2005/06; among these, 3478 (42%) were for psychiatric conditions. The number of people with developmental disability hospitalized for a psychiatric condition represents about 2% of the general population hospitalized for such conditions. Among people with developmental disability hospitalized for a psychiatric condition most were men and people aged between 15 and 34 years. For almost all psychiatric disorder categories, people with developmental disability were hospitalized at rates significantly different than their counterparts without developmental disability. Lengths of hospital stays for psychiatric conditions were very similar when comparing the study groups; however, people with developmental disability were more likely to have 2 or more hospitalizations during the year. Conclusions: People with developmental disability display unique hospitalization patterns, compared with the general population.

Are Cervical and Breast Cancer Screening Programmes Equitable? The Case of Women with Intellectual and Developmental Disabilities.

BACKGROUND Effective cancer screening must be available for all eligible individuals without discrimination. Lower rates of cervical and breast cancer screening have been reported in certain groups compared with women from the general population, such as women with intellectual and developmental disabilities (IDD). Research on the factors explaining those observed differences is crucial to determine whether practices are unfair and could be improved. The aim of this population-based study was to describe cancer screening utilisation by women with IDD in Ontario, Canada compared with other women in Ontario. The specific objectives were (1) to estimate the rates of cervical and breast cancer screening among eligible women with IDD in Ontario; (2) to compare the rates of cervical and breast cancer screening between eligible women with and without IDD; and (3) to examine if any observed differences between women with and without IDD persist after factors such as age, socio-economic status, rurality and healthcare utilisation are accounted for. METHOD This study draws women with IDD from an entire population, and draws a randomly selected comparison group from the same population. It controls for important confounders in cancer screening within the limitations of the data sources. The study was conducted using health administrative databases and registries in Ontario, Canada. Two cohorts were created: a cohort of all women identified as having an IDD and a cohort consisting of a random sample of 20% of the women without IDD. RESULTS The proportion of women with IDD who are not screened for cervical cancer is nearly twice what it is in the women without IDD, and 1.5 times what it is for mammography. CONCLUSIONS Findings suggest that women with IDD experience inequities in their access to cancer screening. Public health interventions targeting this population should be implemented.

Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study

To describe and compare population‐level aspects of diabetes and diabetes primary care among people with and without intellectual and developmental disabilities.

Predictors of emergency department visits by persons with intellectual disability experiencing a psychiatric crisis.

OBJECTIVE This study identified predictors of emergency department use by persons with intellectual disability during psychiatric crises. METHODS Data were analyzed for 576 adults with intellectual disability who were living in three urban centers in Ontario, Canada, and who experienced a psychiatric crisis between 2007 and 2009. Those who visited an emergency department in response to the crisis (N=96) were compared with those who did not (N=480). RESULTS Multiple logistic regression analysis identified one predisposing, three enabling, and two need variables that were significant predictors of emergency department visits: level of disability, type of residence, crisis plan, family physician, history of involvement with the criminal justice system, and history of emergency department visits. CONCLUSIONS Both need variables and variables not related to need predicted emergency department visits by persons with intellectual disability. Prevention efforts should focus on individuals who receive fewer community supports and who have previous emergency department visits.

Understanding Information about Mortality among People with Intellectual and Developmental Disabilities in Canada.

BACKGROUND This paper reviews what is currently known about mortality among Canadians with intellectual and developmental disabilities and describes opportunities for ongoing monitoring. METHODS In-hospital mortality among adults with intellectual and developmental disabilities in Ontario was examined using hospital data. Mortality was compared between age-, sex- and residence area-matched groups of Manitobans with and without intellectual and developmental disabilities using linked administrative data. A retrospective cohort study of mortality among individuals with intellectual and developmental disabilities in a region of Ontario focused on measuring excess mortality and risk factors. FINDINGS There is evidence of excess mortality in persons with intellectual and developmental disabilities in Canada. Some of the excess is attributable to comorbidities that are more common in this population. Women may have a greater risk of death than men. Excess mortality occurs at all ages but is more pronounced in early life. DISCUSSION High-quality ongoing monitoring of mortality among individuals with intellectual and developmental disabilities is possible in Canada. Examination of sex differences should be a priority.

Substance-related and addictive disorders among adults with intellectual and developmental disabilities (IDD): an Ontario population cohort study

Objectives Describe the prevalence of substance-related and addictive disorders (SRAD) in adults with intellectual and developmental disabilities (IDD) and compare the sociodemographic and clinical characteristics of adults with IDD and SRAD to those with IDD or SRAD only. Design Population-based cohort study (the Health Care Access Research and Development Disabilities (H-CARDD) cohort). Setting All legal residents of Ontario, Canada. Participants 66 484 adults, aged 18–64, with IDD identified through linked provincial health and disability income benefits administrative data from fiscal year 2009. 96 589 adults, aged 18–64, with SRAD but without IDD drawn from the provincial health administrative data. Main outcome measures Sociodemographic (age group, sex, neighbourhood income quintile, rurality) and clinical (psychiatric and chronic disease diagnoses, morbidity) characteristics. Results The prevalence of SRAD among adults with IDD was 6.4%, considerably higher than many previous reports and also higher than found for adults without IDD in Ontario (3.5%). Among those with both IDD and SRAD, the rate of psychiatric comorbidity was 78.8%, and the proportion with high or very high overall morbidity was 59.5%. The most common psychiatric comorbidities were anxiety disorders (67.6%), followed by affective (44.6%), psychotic (35.8%) and personality disorders (23.5%). These adults also tended to be younger and more likely to live in the poorest neighbourhoods compared with adults with IDD but no SRAD and adults with SRAD but no IDD. Conclusions SRAD is a significant concern for adults with IDD. It is associated with high rates of psychiatric and other comorbidities, indicating that care coordination and system navigation may be important concerns. Attention should be paid to increasing the recognition of SRAD among individuals with IDD by both healthcare and social service providers and to improving staff skills in successfully engaging those with both IDD and SRAD.

The Uptake of Secondary Prevention by Adults with Intellectual and Developmental Disabilities

BACKGROUND Secondary prevention involves the early detection of disease while it is asymptomatic to prevent its progression. For adults with intellectual and developmental disabilities, secondary prevention is critical as they may not have the ability to recognize the early signs and symptoms of disease or lack accessible information about these. METHODS Linked administrative health and social service data were used to document uptake related to four secondary prevention guidelines among adults with intellectual and developmental disabilities. Rates were compared to those from a general population sample representing the same age ranges. RESULTS Of 22% of adults with intellectual and developmental disabilities had a periodic health examination in a two-year period (compared to 26.4% of adults without intellectual and developmental disabilities). Adults with intellectual and developmental disabilities were less likely to undergo recommended age and gender-specific screening for the three types of cancer studied (colorectal, breast and cervical). CONCLUSIONS Adults with intellectual and developmental disabilities in Ontario experience disparities in secondary prevention. As changes to primary care delivery and secondary prevention recommendations in the province and elsewhere continue to evolve, close monitoring of the impacts on adults with intellectual and developmental disabilities combined with dedicated efforts to increase access is warranted.

Datapoints: Diabetes Prevalence Among Persons With Serious Mental Illness and Developmental Disability

T prevention and treatment of diabetes among individuals with serious mental illness has been a recent focus in part because of the reportedly direct relationship between antipsychotics and metabolic syndrome. Adults with developmental disability are also at high risk of diabetes because of their sedentary lifestyle, cognitive impairments, and deficits in adaptive behavior and are less likely than other vulnerable populations to receive appropriate diabetes care (1). Some individuals with developmental disability also have serious mental illness. Whether they are at higher risk of diabetes than those with either serious mental illness or developmental disability alone has not been studied. We compared the prevalence of treated diabetes in four groups of adults: with serious mental illness, with developmental disability, with serious mental illness plus developmental disability (“combined” group), and a random sample of the general population. We hypothesized that the combined group would have the highest diabetes risk. Data for fiscal 2005–2006 were obtained from the Institute for Clinical Evaluative Sciences, which holds deDiabetes Prevalence Among Persons With Serious Mental Illness and Developmental Disability

A Comparison of Medical and Psychobehavioral Emergency Department Visits Made by Adults with Intellectual Disabilities

Study Objective. We describe and contrast medical to psychobehavioral emergency visits made by a cohort of adults with intellectual disabilities. Methods. This was a study of 221 patients with intellectual disabilities who visited the emergency department because of a psychobehavioral or medical emergency. Patient profiles are described and logistic regression was used to assess predictors of psychobehavioral emergencies in this group, including age, residence, psychiatric diagnosis, cognitive level, and life events. Results. Ninety-eight individuals had medical emergencies and 123 individuals presented with psychobehavioral emergencies. The most common medical issue was injury and the most common psychobehavioral issue was aggression. In the multivariate analysis, life events (odds ratio (OR) 0.28; 95% confidence interval (CI) 0.10 to 0.75), psychiatric diagnosis (OR 2.35; 95% CI 1.12 to 4.95), and age group (OR 4.97; 95% CI 1.28 to 19.38) were associated with psychobehavioral emergencies. Psychobehavioral emergencies were more likely to result in admission and caregivers reported lower rates of satisfaction with these visits. Conclusion. Emergency departments would benefit from greater understanding of the different types of presentations made by adults with intellectual disabilities, given the unique presentations and outcomes associated with them.